by Susan Dunlap
“It is not safe for you here,” the nurse had said, moving her away from Hope Mkema’s bed. “You are still weak.”
No one told her when Hope died. But she heard outside in the town, a dull tapping on metal and wood, thudding from a thousand hands, wood against rough metal.
Hope Mkema’s family, her neighbors and friends, hadn’t blamed Kiernan, nor had they objected when a plane arrived unscheduled, allowing her to be airlifted out. She was too weak to travel alone, and it was Jeff Tremaine who was assigned to accompany her, as it turned out not merely to the coast but on a connecting flight back to Bombay.
And it was Jeff who told her that the dreams and fortune of the area had died with Hope Mkema when she was denied the ribavirin Kiernan hadn’t needed. Odd, she had thought when she woke from exhausted sleep at intervals during the days of travel, what a personal affront death is to Westerners. If Jeff Tremaine could have sued God, he would have. Instead he turned his own guilt on her, and she made no move to deflect it. By the time he left her in a bare-bones hotel in Bombay, she knew that it was time to leave India and go home.
She would have answered this call of his out of gratitude, but she was sure he wouldn’t understand that. He had expected her to come out of repentance.
But she had come out of dread.
CHAPTER 8
DR. LOUISA LARSON HAD made only one faux pas: Grady Hummacher’s boys.
She circled her forefinger around a clump of shoulder-length blond hair, around and around, pulling the hairs harder each time, as if yanking her skin away from her skull would create an escape route for her misjudgments. She stared at the empty examination room in her Las Vegas clinic. She no longer noticed the soft ambers and greens of the desert prints she had chosen to be every bit as nice as those in the clinic across town that supported this one in the barrio. Just a month ago the surprised smiles on her patients’ faces when they entered her welcoming office had made the cost worthwhile. And she wouldn’t have wasted half a month on some distant beach anyway, not when her patients needed her and she had a practice to build. And a community to make her mark in.
After med school a public health guy had talked up applying to a research project in Boston. “Vital, important work,” he had insisted. “A lot of driven types get into it. But they could really use a woman like you, near the top of your class, but also diplomatic. You, Louisa, you sweep people off their feet”—she couldn’t help smiling at that—“and right into your pocket where you wanted them all along.” She had turned him down flat, said You Bet Your Life was not a game she chose to play. But the truth was the guy had made her feel as if he’d cracked her skull open and exposed her mind to the world. She was not about to go to work somewhere where people labeled what she did—focusing on her work and getting everyone else enthusiastic about it—manipulation. She’d worked her tail off in med school. She had no life outside her career. All those years had given her a good view of the failures of medicine, and she damn well planned to be in a position to make changes. You can climb to the top in spite of your competitors, but it’s so much quicker if you can make them see the sense in giving you a leg up. If the research recruiter called that manipulation, then it was no wonder his establishment needed a woman everyone liked.
Manipulation was what Grady Hummacher had done to her. She had never meant him to be more than a diversion. With Grady all the doors were open and there was a prize behind every one. So what if it was all mirage; she didn’t have time for more than that. A delicious diversion, to be dipped into totally, then shaken off, was exactly what she needed.
And then he’d shown up with the boys. “They’re tabulae rasae,” he’d said as if he’d known the perfect bait. “They’ve never heard a sound. They don’t even have a concept of what language is. They’d be ‘backroom boys,’ if their tribe had lived in more than one-room huts.” Grady had stood right here in this examining room, his wiry hair bleached almost white against his tanned face, his elbows barely bent to rest his hands on the boys’ shoulders. Next to Grady’s tough body, his let’s-try-it expression, the boys looked like third-graders, scared, fascinated, exhausted, amazed. Carlos and Juan, Grady called them, though, of course, he could have called them anything. What he did know, Grady insisted, was that Juan and Carlos had no future in the Panamanian rain forest. Their only chance was with her help in the United States. With her standing in the medical community—everyone liked her—she could get the boys the best diagnosticians, surgeons, specialists, therapists. She could change their lives. She could give them lives.
She was intrigued by the challenge, the unlimited possibilities. She was hooked. What she hadn’t factored in was coming to care about them. But it was impossible not to.
Juan was such a sparkler. His eyes were never still, always watching. Was he thinking like we do, she had wondered. Without words was there a mechanism to classify, speculate on experiences, on what other people did? When she got him a sign-language tutor, she would ask him. Could he really go from no concept of words as symbols of things, movements, feelings to philosophical inquiry? Some would say, “Impossible.” But if you limit your goals, you get limited results, and she always looked to the top, for her practice, for herself, and for Juan. She noted Juan’s delight at the refrigerator, and how he couldn’t wait to bring Carlos there and let him play with the door within the door. His face had lit up when he saw the photos of Central America in the coffee table book that had pride of place in the little barrio apartment Grady had set them up in. Homesick, poor kid. Then she had remembered—the Breadfruit Park, as people had labeled the place. It had tropical foliage, as close to the feel of the Panamanian rain forest as they’d find in Nevada. She had gotten Grady a pass and was delighted that he took the boys there—and gave her a day free of them.
Grady had already flown back to Panama the first time when she realized that looking in on the boys, as she’d agreed to, meant more than the occasional ten-minute visit. It was shopping for them, cleaning for them, and cleaning up after them in the case of the first stove fire. After that it was either overseeing the cooking, cooking for them, or arranging for some kind of takeout that they might or might not find too foreign to eat.
And then they got sick! She ran every test. Checked every source. But she was flying blind with them. Poor kids couldn’t even tell her where it hurt. In desperation she had brought them here to the clinic, where she never kept overnight patients, slept on the waiting-room couch, and watched over them like a mother. She had monitored their condition, kept records worthy of the CDC. Maybe she should have taken them to Children’s, but what kind of care would they get there, on an overcrowded ward? Two boys who couldn’t speak, couldn’t understand? She would spend more time there answering questions than she’d spent caring for the two of them here. Why didn’t you bring them sooner? Couldn’t you see the danger of contagion in an impoverished, overcrowded neighborhood? What kind of doctor … ?
She’d never meant to leave them alone. Never would have for anything less than the call from Anne Barrington, already in labor. You don’t tell the governor’s niece to make do with an intern because you can’t get a baby-sitter. The delivery should have taken an hour, not four. She was worried when she drove back here. But she never dreamed the boys would be gone. No way they could have walked out of the clinic with their killer fevers, and the bleeding through the skin. Grady, of course, had taken them. That became real clear when she picked up the police message about the break-in. She could have sicced the cops on Grady. But there’d be so many questions. What kind of doctor … ?
And if they were contagious …
And now at five-thirty in the morning they were gone. Grady Hummacher could have taken them anywhere. Beyond her help. Two-legged time bombs.
CHAPTER 9
KIERNAN ADJUSTED HER MASK, stepped back into the autopsy room, and pulled out the gurney. The woman’s face and neck were swollen grotesquely, the edema almost obliterating her features. The skin had torn from th
e pressure in two places. Postmortem tearing, thank God.
“Kiernan?” a male voice asked.
Kiernan turned, shocked to realize she had been so engulfed in the procedure. Jeff Tremaine eyed her questioningly. She said, “I didn’t hear you come in.”
His pale lips twitched nervously, but he said nothing more. She remembered that about him, the silences. Physically, the last five years had been hard on him. The once athletically lanky torso now seemed gaunt and already past the flexibility of youth. His sandy hair was thinner, shorter, now. His face was weathered rather than lined, the blue eyes she recalled glistening in the African night now were dull, his shoulders stooped from years of bending over the sick. It struck her again, as it had on the plane out of Africa, that Jeff Tremaine seemed to be a different man each time she met him.
The bulky mask hung from his hand, but he made no move to put it on. He nodded toward the body. “It’s overwhelming.” He paused before turning his gaze toward her. “I knew you would understand.”
Understand his fear? “Any doctor who’s seen the effects of arenavirus would get it. You didn’t have to drag me here.”
“I had to know before I reported it. I needed a second opinion. If this is akin to Lassa fever, or Bolivian Junin, or Machupo from Panama, I need to know.”
“No,” she snapped, “you need to be on the horn to the health department and CDC in Atlanta. You should have done that before you called me. What’s stopping you?”
“Look at her. What do you see? Not the effects of disease, but the person. She looks Hispanic. Maybe she’s an immigrant, maybe illegal. Doesn’t matter, though, does it? If word gets out that there’s a threat of epidemic, from her, the government’s going to be breathing down the neck of every immigrant, legal or not. You’re from California, Kiernan, you should know that.”
“I do know, Jeff,” she said, just short of snapping at him. How could she have forgotten the righteous little whine to this voice? She’d heard it long enough on the plane to Bombay. “I’ve seen the results. When going to the clinic means you may be deported, people don’t go. We—the government—are asking for disease to go untreated. The state is turning the barrios into petri dishes.” She looked back at the swollen corpse. “Nevertheless, Jeff, I am not about to open up a body when I have no idea what’s inside.”
He grabbed her shoulder. “We have to know! If I could do the autopsy, I would. I need you.”
She detached his hand. It was shaking. “If you could? We all did postmortems in Africa. You were there way longer than I. Surely you’ve done—”
“Not since Hope. Not on a body like this. I … couldn’t.” He turned to the sink and shoved the faucet full on. Water sprayed onto the wall, the floor, and she could see the fabric of his sleeves darkening with it.
“Okay,” she said softly. “Let’s do a visual. We’ve both seen enough cases of Lassa.” She covered over the tray of clamps and scalpels, picked up the microphone, and handed it to him. “You start. And use your mask and gloves, unless you know something I don’t.”
Her gaze dropped to his hand, and it was clear from his startled expression he had forgotten he was holding the mask.
She watched as he settled the mask in place and fumbled with the gloves as if he hadn’t pulled their like on and off a thousand times. Was it just nerves?
He said, “Well-nourished female adult, looks to be in her twenties. Olive skin, black hair, eyes—”
Kiernan leaned over the woman’s face. Her mask was old and meant to be worn with a breathing tube. Already the visor was beginning to fog. She wouldn’t have much time. Squinting into the face of the dead woman, she said, “Petechia evident in the eyes. There’s so much blood, it’s hard to see the color of the iris. The sclera is almost totally covered; barely a bit of white visible.” She held a magnifying glass nearer to the skin. “Evidence of petechia in the skin too. Some cyanosis evident at the mouth.”
She could hear Tremaine interspersing her observations with his own—“One hundred twenty pounds. Evidence of extreme edema in the face and neck. Facial features distorted by edema”—but his voice began to blend with the rumble of the ancient fan. She lifted the woman’s arm. Stiff. The jaw, too, was locked. “Rigor still in effect. Jeff, when did you discover her?”
“Just before I called you.”
“Here? In the morgue?”
“Yeah.”
She braced her hands on the edge of the gurney and looked directly at Tremaine. “Are you telling me someone walked in off the street and dumped this corpse here and no one in town noticed?”
“Not off the street.”
“What, then, through the roof? Come on, Jeff, stop beating around the bush.”
He smacked down the tape recorder. “It’s not a complicated concept. Out back”—he was speaking as if to a recalcitrant child—“there is an alley. The morgue has a back entry. That’s where the deliveries are made … because … Kiernan … citizens on their way to the cafe don’t find it appetizing to see dead bodies being carted across the sidewalk.”
Her hand went to her mask, and she had to stop herself from pulling it off and striding out the door. “Hey, I’m here as a favor. You can answer my questions civilly or find yourself a more accommodating friend. Got it?”
He started to speak, reconsidered, and stood, pale lips quivering.
“Got it?” Her hand was still on the mask.
He grunted and she decided to accept that as a yes.
“How did this stranger get in?”
“Door’s open. Morgue gets deliveries at odd times. Mortician doesn’t want to be running back in the middle of lunch to unlock the door. Or be pulled away from a funeral to do it. It’s easier to leave the door open.” Before she could question that, he added, “This isn’t San Francisco, you know. People don’t steal everything that’s not nailed down.” He shot a glance at her face and added more conciliatorially, “The formaldehyde and the instruments and such are in locked cabinets.”
“What did the mortician say?”
“Didn’t know anything about it.”
“And you believe him?”
“Yeah. He’s too old to be involved in much more than getting out of bed in the morning.”
Crime or no, it seemed like a slapdash system. “What was the deceased wearing?”
“Over there.”
The pile was small. Navy blue walking shorts, white cotton cap-sleeved blouse embroidered with flowers, white cotton panties, runner’s bra, white socks, and running shoes. “Jeez, what were you thinking? If she’s an illegal immigrant, she’s assimilated real quick.”
“The blouse—”
“Sure, it’s one you associate with Mexico, or with vacations in Mexico, or with import stores. But nylon hip-hugger underpants and a sports bra? And running shoes? This is a couple hundred dollars’ of clothes. What’s going on here?” She did a quick sweep of the body, her gaze coming to rest on the woman’s feet. The leg was still stiff and she had to bend to see the heel. “This is not a woman used to walking barefoot, or probably even in sandals. Look at her heel; it’s almost smooth. That’s a heel that’s been protected and cared for. And her toenails. See the pale peach nail polish? What you have here is a woman who cared about her appearance and had the time to—”
“What about her fingernails, though? They’re a mess.”
“Hmm. Same color polish, heavily chipped; encrusted with dirt or maybe blood. Chances are she had a bad couple of days.”
“But the toes—”
“Jeff, if a woman wears shoes and stockings, toenail polish lasts forever. If nails were soldiers, toes would be the generals sipping bourbon in the Pentagon, and fingers the draftees in the trenches.”
“Strange.” He was looking at the corpse, but his focus was blurry.
Kiernan wished she had known him well enough to guess what was behind those eyes. Was he truly baffled or was he mixing her observation with data he had no intention of sharing? “So what brought this unkn
own woman in here dead?”
His mask had begun to fog, too, and Kiernan couldn’t make out his expression as he said, “Maybe my past. Or because I’m the only one who would take a stand.”
“But you didn’t take a stand, did you?”
“I got you here.”
CHAPTER 10
KIERNAN STARED DOWN AT the dead woman’s grotesquely swollen face. Blood had seeped through her pores, out over her eyes. The neck was still stiff, and Kiernan had to bend to peer through the magnifying glass into the ears. “Looks like petechia there too.”
“That’s what I thought.”
“Was rigor set when you examined her? Could you still get her mouth open?”
“Oh, yes.” It was a moment before Tremaine continued, his voice shaky. “Throat’s almost closed. You remember in Africa talking about raw hamburger, how the Africans were so fascinated by the picture of cellophaned package after package on the open freezer shelf that they lost the point?”
“The point that the patient’s throat looked like hamburger? Are you saying this woman’s throat’s that bad?”
“All esophageal definition is gone.”
Kiernan tilted her head so that she could see into the nose. “Oh, God, poor woman. The edema in the sides of the nose is so extreme, her nose is swollen shut.” It all fit with hemorrhagic fever. If that conclusion held, beneath the skin every organ would be a wreck, jammed with platelets, fluids, dead cells, droplets of fat. Her heart would be clogged with platelets that the body had produced in one last desperate effort against the overwhelming forces of the virus. Platelets would be backed up into the arteries and veins. Lungs would be so jammed with fluid, death could have been from asphyxia. Liver, spleen, kidneys would look like plum aspic. “It’s got all the markers of hemorrhagic fever. But the nose! I’ve never seen anything that bad. It’s not a condition Lassa patients present.”